What question did this study set out to answer?

This study aims to evaluate the effects of acupuncture on inflammatory biomarkers associated with musculoskeletal pain.

May 10, 2026Open Access

Immunomodulatory Effects of Acupuncture on Inflammatory Markers in Patients with Musculoskeletal Pain: A Systematic Review of Randomized Controlled Trials

CLChi Ngai LoMinistry of Social and Family Development MFMatrix Man Him FungUniversity of Hong Kong BLBernard Pui Lam LeungSingapore Institute of Technology

Key Points

This study aims to evaluate the effects of acupuncture on inflammatory biomarkers associated with musculoskeletal pain.
Conducted a systematic review and meta-analysis of randomized controlled trials (RCTs).
Included studies involved acupuncture or dry needling with a focus on inflammatory biomarker outcomes.
Risk of bias was assessed independently by two reviewers using ROB2.
Nineteen RCTs (n = 1492) found acupuncture reduced inflammatory markers like TNF-α in knee OA (SMD = -1.63, 95% CI -2.47 to -0.80, p < 0.01).
No significant effects were observed from acupuncture versus sham for CRP or ESR in arthritis.
Findings indicate modified acupuncture may be more effective than standard acupuncture in reducing TNF-α levels.

Abstract

Background: Musculoskeletal pain remains a major cause of disability worldwide, encompassing disorders such as rheumatoid arthritis (RA), osteoarthritis (OA) and chronic back pain. Acupuncture and dry needling are increasingly used for symptom management, yet their effects on inflammatory modulation remain unclear. This systematic review and meta-analysis evaluated the influence of acupuncture on inflammatory biomarker regulation in musculoskeletal pain. Methods: Following PRISMA and Cochrane methodological guidelines, comprehensive searches were conducted across MEDLINE (via PubMed), Web of Science, Cochrane Library, Scopus, Google Scholar, and OpenEvidence from inception to August 2025. Eligible studies were randomized controlled trials (RCTs) involving acupuncture or dry needling interventions with inflammatory biomarker outcomes. Screening, data extraction, and risk of bias assessment using ROB2 were performed by two reviewers independently. The certainty of evidence was appraised using GRADE criteria. The protocol was registered on PROSPERO (CRD420251011831). Results: Nineteen RCTs and one randomized cross-over study (n = 1492) met inclusion criteria. Some studies demonstrated reductions in CRP, ESR, IL-1β, IL-6 and TNF-α following acupuncture. Random-effects meta-analysis indicated that modified acupuncture (electroacupuncture or needle-knife therapy) significantly reduced TNF-α in knee OA compared with traditional acupuncture (SMD = −1.63, 95% CI −2.47 to −0.80, p < 0.01) but not IL-1β. However, no significant effects were observed from acupuncture versus sham acupuncture for CRP or ESR in patients with arthritis. However, the findings are limited by high heterogeneity and the small number of studies included in each meta-analysis. Conclusions: A moderate level of GRADE evidence suggests that modified acupuncture may be more effective than standard acupuncture in reducing TNF-α levels in patients with OA. Further high-quality biomarker-based RCTs are warranted to confirm these findings. This study received no external funding.

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